Reuters reports that Americans are more likely to have trouble paying medical bills or having trouble seeing a doctor than other adults in high income countries. A poll of 18,000 adults in 10 countries found that Americans tend to have problems getting important care due to the cost or past medical debt, according to a report by the Commonwealth Fund.

Karen Davis, president of the non-profit, which researches health care and advocates for improvements based on their findings, said in a statement “Despite spending far more on health care than any other country, the United States practically stands alone when it comes to people with illness or chronic conditions having difficulty affording health care and paying medical bills. This is a clear indication of the urgent need for Affordable Care Act reforms geared toward improving coverage and controlling health care costs.”

The survey found that 42 percent of the U.S. adults polled who reported having health problems went without care due to the cost, while nearly 25 percent said they had problems paying past medical bills. Australia, Britain, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden and Switzerland all had significanly less respondents complaining of issues relating to medical costs, averaging between 1 to 14 percent of their respondents having trouble affording health care.

It found that 42 percent of the 1,200 U.S. adults with health problems in the survey went without care because of costs, and more than a quarter said they could not pay, or had serious problems paying, medical bills.